This Leave of Absence Request Form shall be used to request time off from work whether you are requesting leave to be paid or unpaid, for all reasons except for work related injuries. For work related injuries please refer to San Mateo County’s Workers’ Compensation Benefits Package which you may obtain from your payroll specialist or Risk Management. An employee granted a leave of absence, unless otherwise provided, has the right to return to a position in the same classification, or equivalent classification in the same department as he/she held at the time the leave was granted.

It is the policy of San Mateo County to provide family and medical leave to eligible employees in accordance with the Federal Family and Medical Leave Act (FMLA) and the California Family Rights Act (CFRA). FMLA/CFRA allows eligible employees 12 weeks or 480 hours of protected time. In addition to FMLA/CFRA rights, the County has a generous leave policy for other types of leaves. See below for instructions and information about the type of leave you are requesting.